From the beginning of Jonathan Rosen’s haunting “story of friendship, madness, and the tragedy of good intentions,” we know how it will end – not only because the story made national headlines, but because the spoiler appears on the book’s jacket. Yet in “The Best Minds,” Rosen tells this story with such a keen mix of compassion and eloquence we can’t help but hope there will be a twist that somehow saves everyone from the inevitably heartbreaking outcome.

The story goes like this: In 1973, when Rosen was 10 years old, his family moved to New Rochelle, New York, down the street from another 10-year-old named Michael Laudor. Both sons of professors, these Jewish, intellectual, basketball-playing boys became inseparable best friends and academic rivals. While Michael was precociously worldly and charismatically arrogant and Rosen was shy and sheltered, they shared the belief that “your brain is your rocket ship . . . we would outsoar the shadow of ordinary existence and think our way into stratospheric success.” They attended Yale together, where Michael graduated summa cum laude with a double major in just three years.

Although the two had always aspired to be writers, Michael continued his meteoric rise by launching into a lucrative consulting position at Bain & Company with the idea that he would spend 10 years making enough money to quit and write full time. But about a year into his job, Michael began struggling with paranoid delusions that eventually led to his mother locking herself in the bedroom and calling the police as her son stood outside the door with a kitchen knife, insisting she was a surgically altered Nazi who was trying to kill him. Admitted to the neuropsychiatric unit at what was then Columbia Presbyterian, he was diagnosed with schizophrenia, a debilitating mental illness for which there is no known cure.

It’s the next part of the story that Rosen grapples with on a personal level and asks us to reckon with as a society as well. Michael was treated with medication, and when he was released to a group home after eight months of hospitalization, his treatment team, believing that a stable, low-stress job would be beneficial, encouraged Michael to apply for a salesclerk position at Macy’s. Instead, he went to Yale Law School, where he “found an adoptive Jewish father behind every classroom door.”

Michael’s classmates assisted with the work he couldn’t manage while he faced the side effects of his medication and his daily delusions, including the recurring belief that his dorm room was on fire. It was in law school, too, that he began dating Carolyn (Carrie) Costello, who would later become Michael’s fiancee. After Michael’s graduation, a New York Times article featured him as a shining example of what people with schizophrenia could accomplish. In the piece, Michael spoke about the unjust stigma he faced as a job applicant with a mental health condition, and he dismissed a query about whether he was violent as “a common and painful stereotype.”

The article led to a $2.1 million windfall: a book contract with Scribner and a movie deal with Ron Howard’s Imagine Films, with Brad Pitt attached to star. If Michael had been the brilliant golden boy growing up, now he had become the poster child for the unlimited potential of those with psychiatric illnesses. Yet less than three years later, struggling to write his overdue book and having stopped taking his medication, Michael, in the grip of psychosis, brutally killed Carrie, his pregnant fiancee, in their apartment.

“The Best Minds” is Rosen’s masterful attempt to reconcile what happened to Michael, Carrie, and their families and friends, and how – or if – their story might have gone another direction. More than half a century later, Rosen looks squarely at his friendship and the ways in which a culture that reveres intellectual achievement can blind itself to the limitations of that same person’s mind. (“Brilliance was so highly prized in our world that it seemed to guarantee all the other brain functions.”)

He examines the history of how we treat mental illness and how political correctness around naming the real dangers of those affected might inadvertently cause us to neglect their needs. Throughout the book – which is part memoir, part manifesto – Rosen asks uncomfortable but crucial questions, some of them unanswerable, all of them compelling, and the result is an incisive but intimate tour de force that’s as much about Michael’s story as it is about the stories we tell as a culture – what we value, what we see and what we do our best not to see even when it’s right in front of us.

The question looming over the entire narrative, which is interspersed with a fascinating and disturbing history of deinstitutionalization, is how to care for people with mental illness in a way that is safe for both them and society at large. In the name of autonomy, Rosen explains, many patients get care only once a crisis occurs that otherwise might have been averted: “Violence and mental illness have been legally entangled ever since dangerousness, rather than illness, became the necessary prerequisite for hospitalization.”

Rosen deftly moves from this kind of historical analysis to the deeply personal, from sobering to often funny, sometimes in the same paragraph. He tricks us into thinking he’s talking about Michael when he’s really talking about all of us: What are the limits and obligations of friendship? Where is the line between accommodation and harm? Can you separate the behavior from the person, or are they inextricably linked? Nor does he shy away from hard, complicated questions about the quality of life necessary to make life worth living.

Rosen seems eager to leave no stone unturned in his exploration, and as a result there are several long sections in this 522-page book that drag the narrative. I would like to have seen those replaced with more transparency around how Rosen feels about Michael now. In his visits at the locked facility where Michael resides, Rosen never asks Michael if he understands that he killed Carrie, and I had to wonder whether he avoided these kinds of tough questions to protect his friend’s psyche or to protect his own. This omission reminded me of something Rosen wrote about their time in college: “We carried the world of each other’s childhood in our pockets like a kryptonite pebble, a fragment of the home planet.”

Up until this point, Rosen is fiercely honest about their complicated relationship. Through early adulthood, Michael isn’t portrayed as a saint or even a good friend at times. Rosen never tries to make Michael anything other than what he is – human – even before his illness struck. Or had his illness always been there? In describing Michael’s quirky personality and unusual behaviors as a child, Rosen wonders, Was this a sign? Was that? He tries to reconstruct it, to find the clues, to imagine there’s a way to wrap our minds around these kinds of tragedies.

Near the end, Rosen points out that our ability to imagine what doesn’t exist separates us from other species and makes us human. “In that regard,” he writes, schizophrenia “is the most human of disorders, a reminder of how remarkable our minds are. It’s like the Tin Man realizing he has a heart because it’s breaking.” What makes “The Best Minds” so affecting is that we can easily imagine a different story for Michael and Carrie, one in which, as Rosen puts it with elegant simplicity, Michael could return to “a time when his brain was his friend and not his enemy.”

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